Duties and powers of the Health Insurance Policy Implementation Board in Vietnam

Duties and powers of the Health Insurance Policy Implementation Board in Vietnam (Internet image)

Regarding this issue, LawNet would like to answer as follows:

1. Position and functions of the Health Insurance Policy Implementation Board in Vietnam

The Health Insurance Policy Implementation Board is a specialized unit assisting the General Director of Vietnam Social Insurance (hereinafter referred to as the General Director). It has the function of advising and assisting the General Director in developing policies and laws on health insurance; managing and guiding the organization and implementation of health insurance policies in medical examination and treatment under health insurance according to the provisions of law.

The Health Insurance Policy Implementation Committee is under the direct and comprehensive management of the General Director.

(Article 1 of Decision 1216/QD-BHXH 2020)

2. Duties and powers of the Health Insurance Policy Implementation Board in Vietnam

Duties and powers of the Health Insurance Policy Implementation Board are specified in Article 2 of Decision 1216/QD-BHXH 2020, including:

- Advise and assist the General Director:

+ Participate with state agencies in developing, amending, and supplementing legal documents on medical examination and treatment under health insurance; pay for medical examination and treatment costs covered by health insurance; scope of benefits and benefits of health insurance participants; and other relevant documents.

+ Develop and submit to competent authorities strategies, long-term, five-year, annual plans, and other projects and schemes of Vietnam Social Insurance in the field of health insurance within the unit's functions; advise on the organization of implementation after approval.

+ Manage and use health insurance medical examination and treatment fund; health insurance medical examination and treatment reserve fund; balance of the health insurance medical examination and treatment fund at the Social Insurance of provinces and centrally run cities (hereinafter referred to as Provincial Social Insurance); Directing health insurance appraisal work; Direct the implementation of measures to control medical examination and treatment costs covered by health insurance, protect the rights of health insurance participants, and prevent and combat fraud, abuse, and profiteering from health insurance regimes.

+ Participate in the National Advisory Council on Drug Bidding, the Drug Price Negotiation Council and other councils related to the organization and implementation of health insurance policies according to the provisions of law.

+ Guide the organization and implementation of health insurance policies in medical examination and treatment; Guide and direct the Provincial Social Insurance, Ministry of National Defense Social Insurance, and People's Public Security Social Insurance to participate in drug bidding according to regulations.

+ Instruct the Provincial Social Insurance, Social Insurance of the Ministry of National Defense, and Social Insurance of the People's Public Security to organize the registration of initial medical examinations and treatments for people with health insurance cards; Sign and implement medical examination and treatment contracts covered by health insurance with medical examination and treatment facilities that meet the conditions and professional and technical standards according to regulations.

- Help the General Director direct and guide the Provincial Social Insurance, Ministry of National Defense Social Insurance, and People's Public Security Social Insurance to implement: Payment and settlement of medical examination and treatment costs covered by health insurance with medical examination and treatment facilities and direct payment to health insurance participants; the allocation and adjustment of health insurance medical examination and treatment expenditure estimates of health insurance medical examination and treatment facilities; the management, use, and payment of drugs, chemicals, medical supplies, and technical services in medical examination and treatment covered by health insurance; the organization and implementation of health insurance appraisal work throughout the Industry; Check the implementation of provincial social insurance.

- Participate in the process of selecting contractors to provide drugs and medical supplies for national-level centralized purchasing of drugs and medical supplies and drug price negotiations organized by the Ministry of Health; participate in appraising the drug supplier selection plan of hospitals under the Ministry of Health and other ministries and branches at the request of the Ministry of Health.

- Announce the price of each winning drug, the average price of the winning drug paid from the health insurance fund of each hospital, locality, and the Ministry of Health; the winning bid price of medical supplies is according to the decision approving the contractor selection results for national-level centralized bidding, local-level centralized bidding, and individual bidding of each medical examination and treatment facility nationwide on the Electronic Information Portal of Vietnam Social Insurance.

- Preside and coordinate with relevant units to develop reporting and statistical forms related to medical examination and treatment under health insurance.

- Coordinate with relevant units to participate in building a health insurance management database; Update and build a system of data, documents, and information on drugs, chemicals, and medical supplies provided to the Provincial Social Insurance, Social Insurance of the Ministry of National Defense, and Social Insurance of the People's Public Security to serve bidding, control, management, and payment according to the health insurance regime; Effectively exploit and use medical examination and treatment data under centralized health insurance in the field of management according to industry regulations; Build a national database on insurance in the field of health insurance.

- Annually develop a check on estimates of medical examination and treatment expenses covered by health insurance; the plan to allocate and adjust the cost estimates for medical examination and treatment under health insurance of the Provincial Social Insurance, the Social Insurance of the Ministry of National Defense, and the Social Insurance of the People's Public Security shall be transferred to the Department of Planning and Investment.

- Evaluate and submit to the General Director to promulgate the health insurance appraisal process; coordinate with the Center for Health Insurance Assessment and Multi-Line Payment to develop, amend, and supplement assessment rules and develop functions of the health insurance assessment information system.

- Preside over developing and guiding the implementation of methods for paying medical examination and treatment costs under health insurance. Coordinate with relevant units to determine medical service prices; and lists of drugs, medical supplies, and technical services within the scope of the benefits of health insurance participants.

- Preside and coordinate with relevant units to appraise the annual settlement of medical examination and treatment expenses for health insurance of the Provincial Social Insurance, Social Insurance of the Ministry of National Defense,
The People's Public Security Social Insurance transferred the Department of Finance - General Accounting, settlement reports, and financial reports of the entire Industry.

- Coordinate with relevant units in inspection; resolve the complaint report; resolve recommendations and problems of organizations and individuals related to the implementation of health insurance policies within the scope of assigned authority.

- Be responsible for data in professional software within the functions and tasks of the management unit.

- Participate in: Scientific research; administrative reform; emulation and commendation; IT applications; applying the Quality Management System according to TCVN national standards; propagating and disseminating health insurance policies; international cooperation; and training, fostering, and professional training according to assigned functions and tasks.

- Implement information, statistics, and reporting regimes; clerical and archived according to regulations.

- Manage civil servants, public employees, and assets of the unit according to regulations.

- Perform other tasks assigned by the General Director.

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